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The Why, How, and What, Behind Bundled Care Payments

May 2, 2017

In today’s political environment, more Americans are turning a critical eye toward our health care system. The government, the media, our country’s health care workers, and everyday citizens are offering analysis, opinions, and proposed solutions for whatever problems (both perceived and real) they find to be plaguing the system.

One such solution, which has shown actual positive results right here at Hebrew Rehabilitation Center, is the Bundled Payments for Care Improvements (BPCI) initiative, developed by the Centers for Medicare and Medicaid Services (CMS) Innovation Center.

WHY IT’S NEEDED:

Historically, Medicare and Medicaid have made separate payments to health care providers for each illness or course of treatment faced by a patient. According to CMS, “This approach can result in fragmented care with minimal coordination across providers and health care settings. Payment rewards the quantity of services offered by providers rather than the quality of care furnished.”

In other words, services are costlier, less efficient, and worse for patients.

To help combat this issue, the Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models in hopes of reducing CMS costs while preserving or improving the quality of care. At Hebrew Rehabilitation Center, BPCI has done just that.

HOW IT WORKS:

For post-acute providers (skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals or home health agencies) care is “bundled” by “episode” rather than an itemized list of treatments. This episode begins as soon as the patient starts to receive post-acute services and lasts for a set amount of time, depending on the ailment. During this set period, the patient is the responsibility of the post-acute provider, whether they are being cared for at the post-acute facility or elsewhere. When the period of time for that episode has ended, the patient’s care costs are reconciled against a predetermined rate per episode. If the costs were lower than the predetermined rate, CMS and the care provider share the savings.

This potentially puts money back into the hands of CMS (which is good for taxpayers) and gives the care provider an incentive to provide the best quality care possible, not just the most care possible. Providers are incentivized to cut down on wasteful over treatment while still keeping patients as healthy as possible.

Here is an example: If Mary - a knee replacement patient - becomes sick with pneumonia during her 30-day episode and must go back to the hospital, she is still the responsibility of the rehab center, even though she is no longer under their roof. This ensures that rehab center works efficiently and effectively to keep Mary in the best health possible, without drawing out her stay or over treating her ailments.

WHAT RESULTED:

For Hebrew Rehabilitation Center (HRC) the results of this initiative could not have been better. In the year since this program has started, HRC has saved Medicare $1.2 Million. Having only 98 beds, this is quite a feat. More importantly, efficiency has improved while retaining and even improving the quality of patient care. The average length of stay per patient has dropped by three days, while patient satisfaction rates are the highest ever recorded.

Clinicians at HRC attribute these results to better communication all around, and a feeling of ownership for each patient – from before they come through the door, until long after they go home. HRC case managers are coordinating with the acute care hospitals before the patient arrives, communicating with families and home-care providers about discharge needs from day one, and working with patients toward their goals throughout their entire episode of care.

Brian Murphy, Senior Director of Admissions and Referral Services at HRC put it best when he said, “We’re more efficient, we create better relationships, and we help patients reach their goals (usually getting home faster) by changing the way care is delivered. It’s in everyone’s best interest to get it right.”

About Hebrew Rehabilitation Center in Boston and Dedham
At Hebrew Rehabilitation Center (HRC) our long-term chronic care hospital license allows us to offer comprehensive medical programs and therapies that meet the special needs of older adult patients. We understand the important role families play in our patients’ care and view each patient as an individual with a unique set of goals for care. We offer a long-term chronic care program, a medically acute care program and outpatient rehabilitative and specialty therapies. Our post-acute Rehabilitative Services Unit is also located at both HRC locations.Learn more

Severity of Kyphosis and Decline in Lung Function: Findings from the Institute for Aging Research (IFAR)

September 14, 2016

Researchers from the Harvard-affiliated Hebrew SeniorLife Institute for Aging Research (IFAR), have published a recent article in Journals of Gerontology: Medical Sciences, suggesting that preventing or slowing progression of hyperkyphosis may reduce pulmonary decline in older adults. Hyperkyphosis is a poorly understood condition that causes an extreme forward curvature of the spine and affects as many as 20 to 40 percent of older individuals.

“Clinically, we know hyperkyphosis restricts expansion of the lungs and causes difficulty in breathing, as well as other serious health problems,” said Amanda Lorbergs, a post-doctoral scientist at IFAR and lead author of the study. Lisa Samelson, senior investigator for the study, associate scientist at IFAR and assistant professor at Harvard Medical School, added, “Our findings are highly important, because they are based on pulmonary function data collected in a prospective cohort followed over a long period, allowing us, for the first time, to quantify the impact of hyperkyphosis on declines in lung function.”

Samelson’s team used data from the Framingham Heart Study that has collected information from generations of Framingham residents and their offspring since the 1940s. The researchers found that women who had the most severe kyphosis had the greatest declines in lung function. Moreover, the loss of lung function due to hyperkyphosis is comparable with the loss of lung function resulting from smoking 15 cigarettes per day over a span of 16 years.

Pulmonary impairment is a leading cause of morbidity and mortality in older adults. By quantifying the impact hyperkyphosis can have on pulmonary impairment, this study highlights the importance of developing approaches to prevent or reduce hyperkyphosis in seniors as they age.

About the IFAR Musculoskeletal Research Center
The overarching objective of the Musculoskeletal Research Center at IFAR is to conduct research and disseminate findings on common musculoskeletal conditions of aging such as osteoporosis, osteoarthritis, hyperkyphosis (excessive forward curvature), sarcopenia (loss of muscle mass) and foot disorders, as well as biomechanics of the skeletal system. We promote interdisciplinary research to understand the mechanisms underlying musculoskeletal diseases. We test interventions to prevent the occurrence of disease, their progression and disabling outcomes in older adults.

Q: You have worked at HSL for a number of years. Can you share a little bit about your previous positions?

A: I have worked at HSL for 11 years. My first role was as a clinical nurse specialist, and I worked for the Nursing Education and Training Department where my primary role was to educate nursing staff and help support clinical practice on the floors. Two years after arriving I moved from this position to the Director of Nursing Education and Training. The position evolved to extend beyond nursing and the department name changed to Professional Development, which included career development opportunities and leadership training in addition to ongoing clinical education and support. During the past four years I had the privilege of taking on the position of Chief Nursing Officer and Vice President of Patient Care Services. This position continues to evolve and allows me to set the vision and the nursing practice standards across the organization.

Q: What first attracted you to HSL?

A: It has always been the reputation of the organization. As a staff nurse in a Boston hospital, we often took care of patients from Hebrew Rehabilitation Center and always commented on the exceptional care that was clearly provided. Having the opportunity to learn about the organization, as well as learn about nursing outside of the acute care setting, was particularly important to me. The HSL continuum is unique, and I believe, the wave of the future.

Q: What are the big changes you have seen over the years?

A: There have been many changes but the most transformative has been the evolution of post-acute care and community services. Changes in the reimbursement structure from the Affordable Care Act have challenged the entire health care community to evaluate how we provide services. HSL has always been responsive to the needs of our seniors, recognizing that keeping them in their home as long as possible, living the highest quality of life is at the core of our mission. At the same time, providing the highest quality supportive housing and long-term chonric care when those environments offer the best care in the best place at the right time.

Q:Looking ahead, what are the biggest challenges you face?

A: As we navigate the ever changing challenges of health care reform, we will be challenged to balance all of our core values. All of health care is being challenged to reevaluate how it provides care, and we are fortunate to be invited participants with area acute care facilities to understand and respond to changes in the environment, while always keeping the quality of care and services in the center of our decision making.

Q: As an advocate for seniors, what do you want professionals to know about you and the nursing staff at HSL?

A: Our staff does the little things that make a big difference in the lives of our seniors and their families. The level of caring and desire to have a positive impact on the quality of life of each resident is second to none. Our staff often state with pride, we focus on what you can do, not what you cannot do. Autonomy and choice are a central part of the philosophy.

Q: What are you passionate about (professionally)?

A: I am most passionate about creating an environment that includes high touch in an era of high technology. I wish to encourage human connection as the main focus to help a resident or patient navigate through health care challenge.

And I believe that best performing organizations will master the balance of quality of care and quality of life. In order to accomplish this goal, employees must also be well cared for so they can give of themselves in a fast paced health care environment.

Hebrew SeniorLife Launches New Website and Blog with Section for Health Care Professionals

December 21, 2015

We are excited to announce the recent launches of our brand new website, Hebrew SeniorLife.org, and blog, blog.hebrewseniorlife.org. The new website makes it easier than ever to find information for prospective residents, patients and families while learning more about our communities and health care services. Visitors can also access our resources, like videos and expert-written guides, and reach out directly to HSL staff. In addition, the “For Professionals” section offers names and contact information for staff members who are ready to help you. We also highlight a number of professional events and invite you to attend.

Our blog has the same great content, improved navigation and emphasis on imagery, which really captures what makes HSL communities and services so unique. We are proud of the changes we’ve made to improve our websites and capture what our organization is all about. We hope you like the changes, too!

Clinical Best Practices for Advanced Dementia Care

August 25, 2015

The number of persons affected with Alzheimer’s disease in the United States is projected to increase to approximately 14 million by 2050. Physicians and other clinicians understand that estimating life expectancy in cases of advanced dementia is difficult.

Seniors and Their Personal Health Information. What’s at Risk?

What a recent study tells us about independent seniors and their personal health information

We like to think that our personal health information is secure and protected. No one wants their health information to fall into the wrong hands.

But what happens when an adult child wants access to the health information of their elderly parent?

In a recent study, completed by Beth Israel Deaconess Medical Center with residents at Hebrew SeniorLife independent living communities, it was found that independent seniors don’t like losing control of their decision-making abilities and wished to maintain control of their health information. Researchers found that the driving force behind this line of thinking is that sharing access with adult children would increase their children’s anxiety and burden them with the problems of their parents. Some adult children may disagree, feeling that the stress of not knowing a parent’s health status is a heavier burden than if they were clued in and could help relieve mom or dad’s stress by pitching in as a family caregiver.

Can adult children and their parents agree on when sharing access to personal health information should be permitted? I think of my own parents who didn’t always agree on what information to share with me. Maybe they didn’t want to cause anxiety. I know they were not trying to be “difficult.”

Maybe, as the study discovered, “fluidity” is the key. It’s not about turning over all information at once, but about weighing each situation and making a decision about sharing health information on a case-by-case basis. Seniors interviewed for the study felt overall that if health information must eventually be shared with adult children, it should happen gradually.

Because preferences change over time and the information a senior decides to share today may be different from what he or she shares in the future, we can hope that tools, like online portals that allow seniors to invite family members into their care, will accommodate everyone’s needs.

After all, a son or daughter with good intentions can be his or her parent’s best advocate.

A Case for Culture Change in Long-Term Care

August 25, 2015

Hebrew Rehabilitation Center has successfully shifted its culture toward one in which residents have more choice and control over their daily activities. This case study, published by Paraprofessional Healthcare Institute, describes how, despite an older building, HRC leaders build trust, strengthen core communication skills, and engage their staff in putting a person-centered vision into practice. What can long term-care facilities learn from HRC?

I sat down with Rabbi Amy Goodman during her first week as Rabbinic Director for Hebrew SeniorLife Hospice Care. She hopes that this Q&A will help her engage with health care professionals throughout Greater Boston and encourages you to reach out to her and schedule a time to meet to continue the conversation. Contact Rabbi Goodman at amygoodman@hsl.harvard.edu or (781) 234-9950.

Q: What brings you to Hebrew SeniorLife?

A: I am very excited to join the Hebrew SeniorLife community as Rabbinic Director of HSL’s Hospice Care. This position is a beautiful marriage of my experience in non-profit management and education, and community outreach. I’m passionate about providing pastoral care at the end of life and in the context of advanced illness.

Q: Are you relocating?

A: It is quite a homecoming for me; I am relocating back to Metro Boston having spent the last seven years studying and working in New York City.

Q: Where did you work before coming to Hebrew SeniorLife?

A: I was the Associate Director of Development for the Metropolitan Jewish Health System Foundation in New York City for the past two years. In that position, I engaged with our hospice patients and their families in their desire to share their gratitude and to support our hospice and palliative care programs.

Q: Can you share a little about your education and background?

A: I received rabbinic ordination through Hebrew Union College-Jewish Institute of Religion (New York) and served for two years as rabbinic intern at Mt. Sinai Hospital in Manhattan as part of their Palliative Medicine Service. I also served as rabbinic intern at Zicklin Jewish Hospice Residence in Riverdale (Bronx), New York. I held various chaplain and rabbinic internships at congregations and in hospitals in Connecticut, Pennsylvania, and Long Island and Queens, New York.

Q: What goals do you have for your new position at Hebrew SeniorLife Hospice Care?

A: My short-term goals are to help grow the number of individuals with advanced and terminal illness who are receiving care from our hospice program. I think that we are in a critical position to change the conversation in our community about advancing age, and empowering patients and their families to make choices that match their values, goals for care, and wishes in the face of advanced and terminal illness.

My long-term goals are to help change the entire conversation we are having about hospice and care in the face of serious illness and increase the impact HSL Hospice has on the Greater Boston region.

This impact is both in the number of patients to whom we provide hospice care and in our reach into the community. Through education and counseling I hope to help people in our Boston community discover what their personal choices are for care at the end of life, and what options are available to them among and within hospice providers. We are in the best position to provide the right care, in the right setting, at the right time when patients and their families know what their wishes are.

Q: What are your first impressions of HSL?

A: I have been overwhelmed by my welcome and the number of people who greeted me with a smile, a hug and an outpouring of excitement. And more than one person told me: “I was told to come meet you.” I am so grateful for the warmth. This is the warmth and openness that I have observed my colleagues throughout Hebrew SeniorLife sharing with our patients, residents and their family members. So I guess it means I’m already a full-member of the HSL community!

Q: What words of encouragement can you offer to someone who is struggling with a major decision about hospice care?

A: Think for a moment – if you were told you had only a short time to live, with whom, where and how would you like to spend your time? If you had a serious illness, would this change your answer? Conversations about receiving hospice care are really conversations about how you want to live your life. None of us can live forever, and given our limitations there may be wishes that are unable to be fulfilled. But if remaining in the place you call home, spending more time with family and friends, and living free from pain and discomfort are your goals, hospice care can help you achieve all of those.

I would also encourage families to have discussions about care in the face of advanced illness even before you are facing illness. Talking about hospice and advanced care options can be really instructive in determining how you would like to receive care. And just because you talk about it doesn’t mean you are signing up!

Jewish Family & Children’s Service Transfers Home Care Services to Hebrew SeniorLife

May 6, 2015

Executive Director Idriz Limaj talks with Jennifer Davis, HSL Director of Marketing Communications, about what this means for the future of HSL Home Care.

Why did Jewish Family and Children’s Service (JF&CS) transfer its VNA and home care programs to Hebrew SeniorLife?
With the backdrop of change in all areas of health care, including the realignment of providers to promote better management of the continuum of patient care, JF&CS decided to proactively pursue the transfer of VNA and home care programs to another like-minded organization. JF&CS leadership identified HSL as an organization that shares their values and could be counted on to continue their commitment to their patients, employees and community. Given the depth and breadth of our clinical services and strong reputation in the Jewish and Russian communities, they felt confident that the transfer serves both organizations and the community well.

Why was HSL interested in taking on new services at this time?
Because we share a similar mission and goals, we felt comfortable partnering with JF&CS to ensure that the services they had been providing to seniors in their service area would continue. At the same time, this opportunity allowed us to expand our coverage area to include more neighborhoods in the Greater Boston area, enhance our presence in Brookline, and add Russian-speaking staff. This move is in line with HSL’s emphasis on developing services that deliver health care to seniors where they live – providing the best care in the best place. Also, the addition of the Aging Services Access Points (ASAP) contract is compatible with HSL’s mission, which states that “we accept special responsibility for the frailest and neediest members of our community who are most dependent on our care.”

What does this transfer mean for HSL Home Care services?
This move represents an expansion of HSL’s medical and private home care services both programmatically and geographically.

Transfer of services expands the HSL service area to include Dorchester, Roxbury, Belmont, Arlington, Wellesley and a larger percentage of Brookline.

Additional services include ASAP (Aging Services Access Points) non-clinical personal care and expanded diabetes care. The ASAP contract is very much in keeping with HSL’s mission to meet the needs of all seniors, regardless of income.

Additional reimbursement contracts increases accessibility to HSL Home Care services for more seniors in the Greater Boston area.

Russian speaking care providers are now on the HSL Home Care staff.

What does this transfer mean for patients and their families?
Continuity of care should feel seamless as the result of close ties between JF&CS and HSL, as well as our shared commitment to provide high quality care so those we serve can maintain independence in their own homes. We worked hard to ensure that all existing patients would continue to see the same care givers. Almost all of JF&CS’s VNA and home care services staff have joined HSL. Home care also represents an access point to HSL’s continuum offering better coordination of care should patients need additional services.

What are the benefits of the transfer of services to HSL’s referral sources?
Health care professionals who refer patients to home care will continue getting the services they are used to getting from JF&CS, but with addition of new programs, and access to more rehabilitation care offered by HSL. Our comprehensive continuum of services offers the opportunity for enhanced care coordination and better transition management for patients from one environment or service to another. In addition, the transfer of JF&CS’s home care services to HSL has expanded our coverage area, as well as insurance contracts so we can now serve more of our referral sources’ clients in more towns.

What do you see as the future for HSL Home Care services?
I look forward to adding more services to HSL Home Care including:

More specialized programming and refinement of existing programs such as our orthopedic and diabetes programs to better meet the needs of future patients

Introduction of community-based palliative care

Improved care coordination

Expanded coverage area

Partnerships with other organizations, ACOs, hospitals, and other home care groups

Hebrew SeniorLife Takes Part in Alzheimer’s Symposium at Harvard College

May 6, 2015

By Elaine Abrams, Program Manager, Alzheimer’s & Dementia Care at Hebrew Senior Life

Hebrew SeniorLife once again teamed with the Harvard College Alzheimer’s Buddies (HCAB) to sponsor the second HCAB Interdisciplinary Symposium on Alzheimer’s Disease, which took place on Saturday, April 18, 2015 at Harvard College. The symposium was hosted by Meredith Vieira, producer of The Meredith Vieira Show and former co-host of NBC News’ Today show. Vieira’s father and brother were both afflicted by Alzheimer’s disease and she remains a vocal advocate for increasing awareness about the disease.

“By holding this symposium on Alzheimer’s, our goal is to facilitate dialogue among members of our student body and the greater community about the need to be involved,” noted Dobre. “After all, they are our nation’s future caregivers.”

The event, which was attended by over 130 clinicians, educators, students and disease advocates, also included several Hebrew SeniorLife staff members. Mary Moscato, President, HSL Health Care Services and Hebrew Rehabilitation Center, delivered opening remarks, noting the organization’s most recent dementia care initiatives.

“As we await treatment breakthroughs, we are mindful of the need for quality, evidence-based programming and services focusing on achieving optimal quality of life for our residents with dementia and their caregivers,” said Moscato.

The first keynote address was delivered by Dr. Sumer Verma, Medical Director at Briarwood Nursing and Rehabilitation Center. Dr. Verma spoke candidly about the need for medical schools to be more proactive in providing students with adequate preparation to care for aging adults with neurocognitive disorders, including Alzheimer’s disease.

Governor Charlie Baker delivered the second keynote address, focusing on his deeply personal family struggle with Alzheimer’s disease. He spoke eloquently about his mother’s slow, steady decline and of watching his father transform from husband to caregiver. Baker also emphasized the important role of Hebrew SeniorLife, noting that from his earliest time in state government to the present, the organization continues its efforts to be an innovative leader in its approach to the care of aging adults, including those with dementia.

The symposium also included several workshops on topics ranging from the role of art and music to student research projects. Dr. Ruth Kandel, a geriatrician with the Hebrew SeniorLife Medical Group and HCAB faculty advisor, facilitated a workshop on the importance of recognizing behaviors as a form of communication when caring for adults with dementia.

“Participants seemed to find listening to the personal stories about the impact of dementia on both the caregiver and their families especially meaningful,” said Kandel.

Established in 2011, HCAB is a student-run undergraduate organization that partners with Hebrew SeniorLife each semester to address the isolation that residents with dementia face by building meaningful connections through weekly one-on-one visits at Hebrew Rehabilitation Center in Boston. HCAB not only seeks to teach students about both the fragility and strength of human connections, but also empower them to become a new generation of advocates for those affected by dementia.

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